Provider Demographics
NPI:1093292534
Name:NEWBURG, JOEL DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:NEWBURG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-0070
Mailing Address - Country:US
Mailing Address - Phone:716-366-2229
Mailing Address - Fax:716-366-7874
Practice Address - Street 1:4867 W LAKE RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-9613
Practice Address - Country:US
Practice Address - Phone:716-366-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013031-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor